Psychotherapy Bulletin

Psychotherapy Bulletin

Self-Care for Graduate Students

(and all those interested in preventing burnout, maintaining competence, and promoting wellness)

Clinical Impact Statement: This manuscript informs graduate students and all other psychotherapists about the nature, role, and importance of self-care for the prevention of burnout and problems with professional competence, along with the promotion of wellness and clinical competence and effectiveness. Specific guidance is provided to assist readers to develop and implement a personal self-care plan.

You don’t need us to tell you this, but graduate school is a very challenging, demanding, and stressful time. While it hopefully is one of the most exciting, stimulating, and invigorating times of your life, you also must contend with stressors associated with being a graduate student as well as those in your personal life, and how each influence the other. 

Being a Graduate Student

While you may be very interested in learning all that your courses have to offer, actual workload, deadlines, and the pressure to obtain excellent grades (don’t we all want that?) come hand-in-hand with your new experiences. For many, moving to a new area, and leaving one’s support network can also add to one’s stress. Establishing and navigating new relationships within your cohort and with faculty members and supervisors each may be challenges as well. 

Clinical experiences add additional stress even if you love this work. Concerns about your clinical skills, ongoing evaluation and supervision, experiencing imposter syndrome, administrative requirements and deadlines such as documentation of clinical services, and the pressure to accrue needed hours each may add to your experience of stress and pressure (oh, did we forget to mention dissertation? Just add that to the list). 

Having a Personal Life

In addition to your role as graduate student or trainee, there is also who you are as a person. This is something we each bring with us to our roles as students and psychotherapists-in-training. Issues from our upbringing and our personal histories and past experiences may impact us in our student and psychotherapist roles (O’Connor, 2001). Examples include a focus on others’ needs over our own, a desire to master chaotic environments, and continued pursuit of a caretaking role. 

We each also have a life outside of graduate school including family, social, and possibly committed relationships. Finding time for each and addressing challenges in each that may arise over time may impact us. Other important aspects of one’s personal life may include religious or spiritual activities, hobbies and leisure time activities, and part-time or even full-time employment for those experiencing financial pressures. 

Each of us also must respond to and cope with the many potential challenges that may arise in our personal lives. These could include family and other relationship obligations, the need to care for ailing family members, personal illness or injury, roommate conflicts, and so many others. 

How They Impact Each Other

It would be nice to think that we can compartmentalize the personal and professional aspects of our lives and never have one influence the other. Unfortunately, as you likely have already experienced more than once, this frequently is not possible. While we may effectively manage minor challenges and stressors in personal and professional realms, we have our limits, and with enough stress its effects will spill over and impact the other aspects of our life. 

Falling ill or having to respond to a family emergency in the days immediately before an exam or when a term paper is due will likely add to one’s stress and perhaps decrease our effectiveness in studying and writing. Any number of stressors and worries in your personal life that preoccupy you can impact your ability to focus on, and process, information optimally and may detract from your ability to be fully present with clients and to be at your best clinically. Feeling pressure financially to make more money may lead you to commit to work hours beyond what feels manageable in light of all your graduate school obligations which may result in feelings of stress, anxiety, and worry, having a possibly deleterious effect on one’s academic and clinical functioning. 

What Can We Do?

It certainly is possible to take some positive actions to impact or influence some of these stressors, but we do not have complete control over them. It is therefore essential that each graduate student and psychotherapist-in-training make a commitment to the ongoing practice of self-care, actively integrating it into your daily life in multiple ways. Before focusing on what self-care is, and is not, and how to apply it effectively to enhance your ongoing wellness and effective functioning, to reduce the negative impact of the many ongoing stressors in your life (academic/clinical and personal), and hopefully to even thrive and flourish during this exciting, yet challenging time of your life, several important basic concepts are addressed.

Distress

Distress is a subjective emotional response to ongoing stressors in our lives. It is not unusual to experience distress over the course of a semester or year, though not every stressful event you have will lead to distress. Experiences of distress fall on a continuum, from mildly stressful (that one professor’s difficult exam) to nearly debilitating (when its finals week, your cat is sick, and your car breaks down). Much of the time, where you fall on this continuum will be determined by the general level of stress in your life. It is important to realize that experiencing distress does not mean you are weak, incapable, or violating ethics standards; it means you are human. Give yourself grace while responding to your distress in a timely manner. 

Burnout

More serious problems arise when distress is left unaddressed. The terminal phase of distress left unchecked is known as burnout (Baker, 2003). Burnout includes three components, each of which falls on a continuum and may vary over time. These are: emotional exhaustion, something every graduate student experiences to varying degrees over time; depersonalization, a reduction in your empathy, compassion, and ability to connect emotionally with clients in a meaningful way; and loss of feelings of accomplishment, a feeling that we are not achieving goals or expectations) (Maslach, 1996). In a recent study nearly half (48.9%) of surveyed graduate clinicians noted personal burnout, and more than a third (34.1%) reported work-related burnout (Warlick et al., 2021). It is impossible to know how much or for how long we can tolerate burnout until it manifests as problems with professional functioning. The best way to mitigate burnout is to address distress before it becomes burnout, but if you find yourself experiencing more serious symptoms assess where and how you can seek support.  

Vicarious Traumatization

Vicarious traumatization is a phenomenon that occurs among clinicians who work with heavy trauma caseloads or traumatized populations. In working with these groups your empathic engagement with a client’s trauma may result in a noticeable, and possibly distressing change in your understanding of yourself and others (Bride et al., 2007). You may even experience secondary traumatic stress, exhibiting symptoms of post-traumatic stress linked to the aversive details of your client’s trauma. As graduate clinicians, exposure to these clients can occur in a wide variety of clinical settings. The preventive role of ongoing self-care, being alert to the development of secondary stress symptoms, and the active use of one’s supervisors and support network are each essential for promoting wellness and effective functioning. 

Problems with Professional Competence

In graduate school and beyond, your clinical competence should be seen as a dynamic entity that must actively be maintained and protected. Distress, burnout, and secondary traumatic stress can impede that maintenance and cause serious problems over time. Often the impact of impaired competence is not recognizable until its effects have impacted our clients. It may seem tempting to ignore the early warning signs of worsening distress or burnout, hoping they will go away on their own or assuming you can manage it, but in doing so you run the risk of the development of problems with professional competence, which can degrade your ability to access and apply your knowledge and skills effectively to assist clients (Elman & Forrest, 2007).    

Self-Care, Positive Career-Sustaining Behaviors, and Maladaptive Coping Strategies

There are strategies and routines available to you that will make you more resilient and less vulnerable to the impact of the many stresses in your life. The most essential, flexible, and important routine to develop is that of self-care. Self-care is so much more than bubble baths, a nightly beer, chocolates, or a hike on the weekend with friends. Effective self-care could include these activities, but it certainly is not limited to them. It is important to recognize that self-care can be many different things and it should be individualized to fit your preferences, needs, and lifestyle. Self-care can and should include activities that reduce distress and burnout while also promoting your wellness with the goal of thriving and flourishing (Wise, Hersh, & Gibson, 2012). 

The essential importance of self-care is found in Principle A of the APA Ethics Code (APA, 2010), Beneficence and Nonmaleficence, which states “Psychologists strive to be aware of the possible effect of their own physical and mental health on their ability to help those with whom they work.” Additionally, Standard 2.03, Maintaining Competence, mandates that we, “undertake ongoing efforts to develop and maintain [our] competence.” Adequate self-care is essential to preventing problems with professional competence. Thus, we each must develop a personal self-care plan that we implement on an ongoing basis to achieve these goals. 

Creating Your Self-Care Plan

Self-care can include those actions and activities that you find relaxing, rejuvenating, and enjoyable. These activities are different for each person. To develop a self-care plan, consider the stressors in your personal life and professional life, how they are impacting you, what self-care actions you are currently practicing, and which ones you can add to further support your promotion of wellness. Remember the goal of self-care is active prevention of burnout and problems with professional competence. Intentionally integrate self-care activities into your daily schedule, keeping in mind that even small actions can make a big difference over time. Self-care should focus first on adequate rest, a healthy diet, and regular exercise or physical activity. Then, focus on relationships, leisure time activities, and religious and spiritual needs, if relevant. One should stay vigilant about the use of negative coping practices that not only fail to promote wellness but may add to your problems with professional competence. These may include self-medication with various substances, and avoidance or denial of difficulties. 

Communitarianism and Your Competence Constellation

There may be a tendency to isolate and attempt self-care as an independent activity. Feeling we can manage everything on our own, feelings of shame, or concerns that others will view us negatively may lead us to avoid seeking assistance or support from colleagues, friends, and mentors. Several studies have demonstrated that we are not able to accurately monitor and assess our own functioning and competence despite the ethics code’s requirement that we do so, and that in fact, the more impaired our functioning, the less able we are to accurately assess our competence and effectiveness (e.g., Dunning, Johnson, Ehrlinger, & Kruger, 2003; Kruger & Dunning, 1999). We each must look out for, engage with, and support each other for the sake of our personal and professional well-being. 

When building and envisioning your support network, consider what Johnson and colleagues (2012) have deemed a competence constellation. This involves establishing and actively utilizing networks of colleagues for ongoing support and feedback to monitor the quality of care we provide to our clients and ourselves. This model suggests rings of colleagues around you with you utilizing those in the inner ring most actively. Outer rings include other colleagues, friends, and mentors, followed by the culture of our profession. With those in the inner ring, our most trusted friends and colleagues, we engage in the most transparency and both give and receive the most support and feedback. Ongoing open and honest sharing with these colleagues, and their reciprocal sharing with us, are essential for accurate monitoring of each person’s functioning and for giving and receiving needed feedback, support, and recommendations for needed assistance or interventions. 

Creating a Culture of Self-Care

In addition to our engagement in self-care activities to promote our ongoing competence and effectiveness, it is important that we each work collaboratively to create a culture of self-care in our graduate program and clinical settings (Barnett & Cooper, 2009). It is essential that a culture of competitiveness and a focus on who is working the most hours or expending the most effort be avoided. Rather, a culture that emphasizes and reinforces ongoing self-care activities, mutual support, transparency, and a collaborative focus on prevention and caring should be adopted. Working collaboratively with your cohort, talking openly about ongoing stressors, encouraging and facilitating self-care routines amongst each other, and reaching out to peers in distress are some of the behaviors that help build this culture. Graduate programs and training sites may normalize a competitive culture and discourage vulnerability or transparency among students and staff. Hold your faculty accountable for modeling self-care, and challenge unrealistic demands or toxic norms. 

Moving Forward

Each of us faces an ever-shifting balance of personal and professional stressors. The skills and self-awareness you develop while balancing classes, dissertation, clinical commitments, finances, and a social life will be helpful as those commitments become the challenges of starting your career and moving forward with your personal life. Your efforts to address today’s challenges lay the foundation for how you address the many challenges you will confront during your career and life, including a focus on self-care, mutual support with colleagues, and the promotion of ongoing wellness. While self-care does appropriately focus on the self, it can only be truly be achieved with the support of, and engagement with, others. Integrating these activities into your professional identity and daily life should serve you well throughout your career.

Cite This Article

Barnett, J., & Homany, G. (2022). Self-Care for graduate students (and all those interested in preventing burnout, maintaining competence, and promoting wellness). Psychotherapy Bulletin, 57(1), 18-23.

References

American Psychological Association. (2010). Ethical principles of psychologists and code of conduct (2002, Amended June 1, 2010). Retrieved from http://www.apa.org/ethics

Baker, E. K. (2003). Caring for ourselves: A therapist’s guide to personal and professional well- being. American Psychological Association. doi:10.1037/10482-000  

Barnett, J. E., & Cooper, N. (2009). Creating a culture of self-care. Clinical Psychology Science and Practice, 16(1), 16-20.            

Bride, B. E., Radey, M., & Figley, C. R. (2007). Measuring compassion fatigue. Clinical Social Work Journal, 35, 155–163. doi:10.1007/s10615-007-0091-7 

Dunning, D., Johnson, K., Ehrlinger, J., & Kruger, J. (2003). Why people fail to recognize their own incompetence. Current Directions in Psychological Science, 12, 83–87. doi:10.1111/1467-8721.01235

Elman, N., & Forrest, L. (2007). From trainee impairment to professional competence problemsSeeking a new terminology that facilitates effective action. Professional Psychology: Research and Practice, 38(5), 501-509. doi: 10.1037/0735-7028.38.5.501

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Kruger, J., & Dunning, D. (1999). Unskilled and unaware of it: How difficulties in recognizing one’s own incompetence lead to inflated self-assessments. Journal of Personality and Social Psychology, 77, 1121–1134. doi:10.1037/0022-3514.77.6.1121

Maslach, C., & Jackson, S. E. (1996). Maslach Burnout Inventory–Human Services Survey (MBI-HSS). In C. Maslach, S. E. Jackson, & M. P. Leiter (Eds.), MBI manual (3rd ed.).  Consulting Psychologists Press. 

O’Connor, M. F. (2001). On the etiology and effective management of professional distress and impairment among psychologists. Professional Psychology: Research and Practice, 32(4), 345-350. 

Warlick, C. A., Van Gorp, A., Farmer, N. M., Patterson, T., & Armstrong, A. (2021). Comparing burnout between graduate-level and professional clinicians. Training and Education in Professional Psychology, 15(2), 150-158. http://dx.doi.org/10.1037/tep0000328

Wise, E. H., Hersh, M. A., & Gibson, C. M. (2012). Ethics, self-care and well-being for psychologists: Re-envisioning the stress-distress continuum. Professional Psychology: Research and Practice, 43(5), 487-494. https://doi.org/10.1037/a0029446

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